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GENOA HEALTHCARE LLC
CH06723A HIDALGO MEDICAL SERVICES, INC
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Covered Entity Details
Entity Name
HIDALGO MEDICAL SERVICES, INC
Subdivision Name
HMS MED SQUARE CLINIC
Type
HRSA-Funded Health Center
340B ID
CH06723A
Entity Address
114 W 11th St
Silver City, NM 88061-5136
Grant Number
H80CS00744
Participating Start Date
1/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
1007 NORTH POPE STREET, SUITE P
SILVER CITY, NM 88061
Pharmacy Comments
Contract Details
Approval Date
1/11/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Veronica Lassiter, Chief Operating Officer
(575) 542-8384 Ext: 2312
Contract Pharmacy Representative
Genoa Healthcare
Jeff Harnsberger, DOO
(970) 483-1819
Signed By Date
1/11/2017
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